569 - Evaluating Eligibility and Access to Hepatocellular Carcinoma Treatment at a National Referral Hospital in Tanzania

Purpose: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality worldwide, with 85% of cases in low- and middle-income countries.{1}{2} In Sub-Saharan Africa, most HCC cases present at late stages with survival < 16 weeks{3}, but data from Tanzania remain scarce, and little is known about patient characteristics, treatment eligibility, or treatment adherence. This study describes HCC patients at Muhimbili National Hospital (MNH) in Dar es Salaam, TZ, and compares treatment eligibility per the Barcelona Clinic Liver Cancer (BCLC) system with treatment delivery.

Materials and Methods: A retrospective chart analysis was completed from June-August 2025, including 121 patients with CT- or histopathology-confirmed HCC seen by interventional radiology, oncology, or surgery at MNH from April 2019-August 2024 (mean age 45.2 years; 18.2% female). Records were reviewed for demographics, medical history, treatment, and outcomes. Tumor burden on CT was assessed using Liver Imaging Reporting and Data System (LI-RADS{4}). Eastern Cooperative Oncology Group (ECOG) scoring was documented and Child-Pugh class calculated; for patients with missing hepatic encephalopathy information, 3 ranges were imputed. Patients were staged per BCLC guidelines.{5}

Results: Of 121 patients, most were hepatitis B positive (77.3%) with frequent ascites (62.5%) and bilobar disease (50.4%). Only 38% received documented therapy: transarterial chemoembolization (TACE) (6.6%, 8/121), sorafenib (18.2%), or supportive care (13.2%). BCLC staging was estimated for 84 patients. No patients were eligible for resection; 2.4% (2/84) qualified for transplant or ablation (mostly Child-Pugh A, single nodule); ≤14.3% for TACE (Child-Pugh B, multinodular disease); ≤69% for sorafenib (Child-Pugh C, portal invasion); with the remainder for supportive care. At last review, 19% (23/121) of patients were alive, 53.7% deceased, and 27.3% lost to follow-up.

Conclusion: Despite eligibility for life-prolonging therapy in >80% of patients, few received curative or palliative treatments, highlighting a significant gap between therapeutic eligibility and delivery. Incomplete records limited staging accuracy; ongoing work includes reassessment of CT imaging for cirrhosis, nodule size, and portal invasion. Future studies should examine treatment in the context of resource limitations, access, and late presentation.

During the preparation of this work, the authors used ChatGPT-5 for grammar and reviewed the work afterwards. The authors take full responsibility for this abstract’s content.